Citation Nr: 21032030 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 15-28 016 DATE: May 25, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II, as secondary to a service-connected acquired psychiatric disability, is remanded. Entitlement to service connection for a heart condition, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. Entitlement to service connection for vertigo, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded Entitlement to service connection for a vision disability, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1974 to October 1977. The Veteran appeared at a video conference hearing before the undersigned in December 2018. A transcript to the hearing is of record. These claims were previously before the Board in June 2019, at which time they were remanded for further development. 1. Entitlement to service connection for diabetes mellitus, type II, as secondary to a service-connected acquired psychiatric disability, is remanded. 2. Entitlement to service connection for a heart condition, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. 3. Entitlement to service connection for vertigo, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. In its June 2019 decision, the Board directed the agency of original jurisdiction (AOJ) to obtain medical opinions answering whether any of the above-named disabilities were proximately due to or aggravated by the Veteran's service-connected acquired psychiatric disability, to include medications prescribed to treat the same. The Veteran underwent VA examination in October 2020 at which time he was diagnosed with diabetes mellitus, type II, and coronary artery disease. The examiner noted that there was no pathology to render a diagnosis for the Veteran's claim of vertigo. Regarding the Veteran's diabetes mellitus, type II, the examiner stated that diabetes is not clinically linked to the Veteran's service-connected psychiatric disability and/or the medications to treat the same. However, she offered no rationale in support of her opinion. She further opined that it was less likely than not that the Veteran's diabetes mellitus, type II, was aggravated by his service-connected acquired psychiatric disability and/or the medications to treat the same, as there was no medical evidence to support aggravation in the Veteran's medical treatment records. Regarding the Veteran's claimed heart disability, the examiner stated that heart conditions are not medically linked to psychiatric conditions. She opined that it was less likely than not that the Veteran's coronary artery disease was not medically caused by or aggravated by his service-connected psychiatric disability or the medications to the treat the same. However, beyond stating that the conditions were not medically linked, the examiner provided no rationale or analysis to support her opinion. Further, the examiner did not provide an opinion regarding causation or aggravation of the Veteran's claimed heart disability by his claimed diabetes mellitus, type II disability. With respect to the Veteran's claimed vertigo disability, the examiner stated that there was no pathology to render a diagnosis; and therefore, it was her opinion that the Veteran's current complaint of vertigo was less likely than not aggravated by any disability pattern of his service-connected acquired psychiatric disability or medications taken to treat the same. However, upon examination for his claimed vertigo disability, the Veteran reported that the dizzy spells he claimed as vertigo began after the commencement of cardiac medications to treat his heart disability. On remand, an opinion should be obtained addressing this dizziness and whether it is a symptom or side-effect of heart medication, or actually a separate and distinct stand-alone disability. A medical opinion that provides no rationale or an incomplete analysis is not adequate to decide a claim. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Furthermore, when VA undertakes to provide an examination or opinion, it must ensure that it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As each of the foregoing opinions are contain incomplete analysis, the Board finds that remand is warranted to obtain addendum opinions. 4. Entitlement to service connection for a vision disability, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. In October 2020, the Veteran was afforded a VA optometry examination in relation to his claim for a vision disability. Upon examination, the Veteran was diagnosed with bilateral transient refractive error change and vision fluctuation. The examiner opined that the Veteran's vision disability was at least as likely as not related to his claimed diabetes mellitus, type II. As the Board is remanding the Veteran's diabetes claim for additional development, adjudication of the Veteran's vision disability claim at this time would be premature. As such, the matter is deferred. The matters are REMANDED for the following action: 1. Obtain medical opinions addressing the nature and etiology of the Veteran's claimed diabetes mellitus, heart, and vertigo disabilities with a clinician or clinicians other than examiner who performed the October 2020 VA examinations. The clinician(s) must receive a copy of, and review the Veteran's claims file. Upon review of the record and examination of the Veteran, each examiner should respond to the appropriate questions below: (a.) Diabetes Is it at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus, type II, was caused or aggravated by his service-connected psychiatric disability, and/or medications taken to treat his psychiatric disability? (b.) Heart Disability (i.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's heart disability was caused or aggravated by his service-connected psychiatric disability, or medications taken to treat his psychiatric disability? (ii.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's heart disability was caused or aggravated by his claimed diabetes mellitus, type II? (c.) Vertigo (i.) Does the Veteran have a stand-alone disability manifested by vertigo? If the Veteran's dizziness symptoms are simply a symptom or side-effect of another disability or medication, this should be made clear. (ii.) If the Veteran has a stand-alone vertigo disability, is it at least as likely as not (50 percent or greater probability) that such disability was caused or aggravated by any of the following: (1) his service-connected psychiatric disability, or medications taken to treat his psychiatric disability; (2) his diabetes, type II, or medications taken to treat diabetes; or (3) his heart disability, or medications taken to treat his heart disability? All opinions obtained should be supported by a medical explanation or rationale. If in the opinion of the reviewing clinician responses to the questions above cannot be provided without an in-person examination or interview, such should be scheduled. (Continued on Next Page) 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.